Provider Demographics
NPI:1427699792
Name:JENSEN, SHAWN EDWARD (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:EDWARD
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 S NELLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7505
Mailing Address - Country:US
Mailing Address - Phone:702-431-4193
Mailing Address - Fax:
Practice Address - Street 1:2855 S NELLIS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7505
Practice Address - Country:US
Practice Address - Phone:702-431-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist